Acute Normovolemic Hemodilution
Hemodilution simply refers to the process of diluting the blood with another substance. There are various ways that this is done before, during and after the surgical process. When the hemodilution is simply the additive of substance to the blood circulation to make up for volume loss during anemia, the process does not violate any so-called Biblical injunction against storing blood or taking foreign blood into the body.
A doctor who changed that simple hemodilution process into one with a wider application, was Dr. Denton Cooley, the heart surgeon. He developed a heart and lung machine that would divert the blood supply away from the heart and replace the diverted blood with non-blood fluid, making open heart surgery possible. At the time that he first used this machine, he discovered that priming the machine with donated blood was problematic for various reasons and in response, Cooley came up with a way to prime the machine with non-blood product. A side benefit to the non-blood prime was that JW patients consented to the procedure, as long as the blood wasn't removed and stored prior to the surgery starting and the bags of stored blood during the surgical procedure remain attached to the body. A simple concession (that really, was actually meaningless) facilitated this early autologous blood transfusion procedure for JWs.
Dr. Cooley's hemodilution procedures were being pioneered in the late 1960s and the process of removing large amounts of blood prior to and during surgery for re-infusion became to be known as 'acute normovolemic hemodilution'.
In 1970, this procedure was tried on a child for the first time:
Acute Normovolemic Hemodilution
The use of a child's acutely collected blood for reinfusion after surgery was first applied in the US by Myron B. Laver, M.D. in 1970 at the Massachusetts General Hospital. The initial patient was a 7 year old child requiring open heart surgery whose family was committed to refusing blood use on religious grounds.
The medical study that reported this procedure is not available online - Laver, M. B., and M. J. Buckley. "EXTREME HEMODILUTION IN SURGICAL PATIENTS." MICROVASCULAR RESEARCH. Vol. 4. No. 2. 525 B ST, STE 1900, SAN DIEGO, CA 92101-4495: ACADEMIC PRESS INC, 1972.
However, The story of the child and his family was reported on in the January 18, 1971 issue of Newsweek.
The child in this procedure was Terry Johnson, a Jehovah's Witness child. His parents, Mr. and Mrs. Robert Johnson of Athol, Mass., refused blood for Terry and even threatened to not take Terry back home if a court order was obtained to treat him with blood.
The doctors finally came up with a plan that met with approval and this is what happened during the surgery:
Terry's operation was on Oct. 1. During the one and a haf hours he was on the heart-lung machine, 6 pints of Ringer's lactate were administered through his right arm, diluting the red cells in his circulation from 60 percent down to 10 percent. "His blood was thin enough to pass the headline test,"notes Laver. "You could read headlines through it." To compensate for the lack of oxygen-carrying red blood cells, the doctors speeded up his circulation with the pump, making the red cells do double duty. When the surgeons had repaired Terry's heart, the pump was switched off and the blood in the plastic bags flowed back into his body. The Ringer's lactate was excreted normally. Soon, Terry's red bloods were back to normal and since the clotting ability of his blood was unimpaired, his recovery was uneventful.
And that was the first successful acute normovolemic hemodilution to be done on a child. Terry Johnson got to go home with his parents - the same parents who would not have taken him home if he had received life saving blood.
That procedure was done in 1970, reported on in Newsweek in 1971 and written about in a medical journal.
The Newsweek article was included in the WTS publication directed towards the medical profession: Jehovah's Witnesses Alternatives to Blood Transfusions 1973.
The WTS also wrote about this new procedure in Awake! 1972 Apr 8 p.30:
The Journal of the American Medical Association, dated Nov 15, 1971, described a procedure for open-heart surgery that employs "sever hemodilution." Early in the operation a large quantity of blood is drawn off into a plastic blood bag. Though the bag is left connected to the patient by a tube, the removed and stored blood is no longer circulating in the patient's system. It is replaced with a plasma volume expander, which dilutes the blood remaining in the veins and which gradually dissipates during the operative procedure. Near the conclusion of the operation the blood storage bag is elevated, and the stored blood is reinfused into the patient. The New York Times of Nov 9, 1971, reported on a somewhat similar procedure whereby some days before one undergoes surgery as much as four pints of blood are removed and stored. During the operation the person's own stored blood is transfused back into him, thus avoiding the danger of disease and mismatched blood. These techniques are noteworthy to Christians, since they run counter to God's Word. The Bible shows that blood is not to be taken out of a body, stored and then later reused.
For years, the Watchtower's references to hemodilution in their literature consistently said that blood storage outside the body was forbidden. Hemodilution was not actually forbidden, as long as it was just the simple process of adding fluid to the bloodstream to compensate for blood loss.
The WTS does not name the procedure that was approved - ANH with line attached.
Acute normovolemic hemodilution would not receive approval in the WTS literature until 1995.